lifeline FALL 2018
2018 LEGISLATIVE SESSION UPDATE Page 6 TABLE OF CONTENTS |
6 10 4 PRESIDENT’S MESSAGE
6 ADVOCACY UPDATE
10 GUEST ARTICLE
20 ANNOUNCEMENTS CHAPTER 2018 21 UPCOMING MEETINGS & DEADLINES LEGISLATIVE AWARD SESSION UPDATE Recipients 22 CAREER OPPORTUNITIES California ACEP FALL 2018 Board of Directors & Index of Advertisers Lifeline Editors Roster ADVANCED 2018 Sponsors and Exhibitors Page 18 2018-19 Board of Directors Chi Perlroth, MD, FACEP, President Vivian Reyes, MD, FACEP, President-Elect Vikant Gulati, MD, FACEP, Vice President Emergency Medical Specialists of Orange County Page 22 Sujal Mandavia, MD, FACEP, Treasurer Lori Winston, MD, FACEP, Secretary Aimee Moulin, MD, FACEP, Immediate Past President Harrison Alter, MD, FACEP (At-Large) Reb Close, MD, FACEP Independent Emergency Physicians Consortium Page 18 John Coburn, MD, FACEP Carrieann Drenten, MD, FACEP Jorge Fernandez, MD Michael Gertz, MD, FACEP Mission Hospital Page 22 Doug Gibson, MD, FACEP John Ludlow, MD, MBA, FACEP Karen Murrell, MD, MBA, FACEP Mitesh Patel, MD, MBA, FACHE, CPE Philip Fagan, MD Page 22 Hunter Pattison, MD (CAL/EMRA President) Patrick Um, MD, FACEP, FAAEM
Advocacy Fellowship Carrieann Drenten, MD, FACEP, Advocacy Fellowship Director Ventura Emergency Physicians Page 22 Sam Jeppsen, MD, Advocacy Fellow
Lifeline Medical Editor Richard Obler, MD, FACEP, Medical Editor Vituity Page 5
Lifeline Staff Editors Elena Lopez-Gusman, Executive Director Kelsey McQuaid-Craig, MPA, Director of Policy and Programs Lucia Romo, Membership and Education Coordinator Yosemite Page 19 Lauren Brown, Government Affairs Associate Meri Thresher, Administrative Assistant
2 | LIFELINE a forum for emergency physicians in california WELCOME new members! Leonardo Aliaga, MD Steven E. Germany Michael Niechayev Justin J. Assioun Mark Shane Gillispie Malena A. Outhav, MD Salil Babbar Brett David Goodfriend Andres E. Park Linda Baldwin, OMS IV Nicole R. Guillen, MD Akash R. Patel Agnieszka Bar Aaron Heerboth, MD Benjamin Daniel Pirotte Neev Bhupen Batavia Jonathan Jong Nadija Rieser Kersti Bellardi Owen Daniel Kemp, MD Michael Joseph Rushton Michael Charles Bermudez, MD Ellen Bess Kettler Paarth Shah Kelsey Jane Burson Faraz A. Khan Ashwin Rohan Sharma Crista Cabahug Kristen Kobayashi Valerie Stone Clelia Alexandra Clark Katherine Ku Anthony Torres Abdelhamid Fayez Dalia Tianci Liu Hurnan Vongsachang Mark Raymond DeBuse, MD Arion Lochner Peter Vuong David Diaz Conner Marsden Yvette Wang Pradeep Glen D'Souza Nahal Massoudi Eric Wetzel Micaela Finnegan Vikash D. Mishra, MD Andrew Wong Jorge Garcia Michelle Nguyen Julia Yip
100% GROUPS Central Coast Emergency Physicians Loma Linda Emergency Physicians Tri-City Emergency Medical Group Emergency Medicine Specialists of Napa Valley Emergency Medical Group University of California, Irvine Medical Orange County Newport Emergency Medical Group, Inc Center Emergency Physicians Emergent Medical Associates at Hoag Hospital Front Line Emergency Care Specialists Pacific Emergency Providers, APC
FALL 2018 | 3 PRESIDENT’S MESSAGE |
THE GREAT EQUALIZERS
If you can humor me for a second with this analogy: needs are not met otherwise. We are giving vaccinations such as Tdap to prevent tetanus On a hot day, droves of people arrive at the beach, with their families and beach (and diphtheria and pertussis). We are giving chairs in tow, looking for a nice spot to lay down the kids and ice chests and Medication Assisted Treatment to patients start enjoying the sunny day. Regardless of the house you live in, the car you with narcotic addiction and coordinating By Chi Perlroth, their care and path to recovery. We are using drive, and the job position you hold, anyone can come to enjoy the beach. This Smart Medical Clearance forms to medically MD, FACEP is where you can find a wide cross-section of society using a public and natural clear psychiatric patients in a safe, timely, and resource together to do the same thing—enjoy time outdoors with friends and financially efficient manner. We implement Intervention Programs for drunk drivers seen family. I call the beach, the Great Equalizer. in our EDs. As an organization we support I have viewed the Emergency Department(ED) and lives of our society and community ballot measures like Proposition 2 that similarly. No matter your background, your beyond the doors of our ED?” increase mental health care and housing to ease homelessness in California. insurance plan, your status or wealth, you It is well understood and supported by are welcomed into our doors and we are research that if you are homeless you have Each community has a different set of social ready to take care of you with the best that worse health outcomes and four to nine challenges. Even hospital executives agree medicine and technology has to offer. Sadly, times higher mortality than those who are that improving population health is critical the similarities end there. Depending on your not homeless. If you have a psychiatric illness, in improving healthcare, but feel there are insurance type or status, you may not be able your median life expectancy decreases by many barriers to successfully deploying to get prompt follow up with a specialist that 10.1 years while ED visits related to psychiatric population health programs. Here is where is able to manage your complex medical illness have steadily risen. Well, no kidding, the science of Social Emergency Medicine comes in. It is a rapidly growing field. By problem. Depending on your social situation right? Every day we evaluate all of these using a three-prong approach—Research, and the money in your pocket, you may patients, stabilize them, and then discharge, Advocacy, and Education—we can use the not be able to get a ride to your doctors’ transfer, or admit them. But when do we take perspective of the ED to find patterns of appointments. Depending on your lot in life a moment to assess if you made a difference in health inequities, identify social needs that and the balance in your bank account, you their outcomes? How many times do we see contribute to disease, and find solutions may get the best health care in the world or these patients in our EDs and think we don’t to improve health disparities in vulnerable one of the worst. have the time to do something to change the populations. Sound like soft science? There is We have been talking about societal inequities course of their health outcomes? What do we abundant and rigorous research being done for years. Because of, or regardless of, EMTALA, do to intervene with the young drivers who to help us understand what social needs we have looked at ourselves as the white hat arrive hurt or having hurt someone else by affect the health of our patients and I and the specialty - the one that takes care of the sick driving drunk or high? How do we care for California ACEP Board will help use advocacy AND the poor. As the conversation continues the withdrawing narcotic-dependent patient and dissemination of this research to help all to change to include terms like “social who keeps coming to the ED because she has emergency physicians take better care of our determinants of health,” “care coordination,” nowhere else to go when her symptoms get patients in the near future. and “preventable visits or readmissions,” some severe? We, emergency physicians, are our patients’ have replied with “that’s a societal problem” Many of us are lucky to have social workers best advocates because we see the wide or “that’s the government’s problem.” When and case managers in our EDs for several variety of societal problems and we see the have we as a specialty ever stopped solving hours a day. They help provide resources for societal or governmental problems? results of our systems’ failures daily. Maybe patients with unmet social needs and assist in this way we become the Great Equalizers. In my upcoming year as President of California in getting the right level of follow up at the Roy Spence, speaker at the 50th Anniversary ACEP, I feel so thankful to be surrounded by a right place. However, during after-hours of ACEP this month remarked, “Aristotle may group of incredibly diverse and experienced when those resources have gone home or have said it the best. ‘Where your talents and Board Members who are already hard at work if we never had those resources in our EDs the needs of the world cross, there lies your tackling the issues that we all face through in the first place, we excuse ourselves by vocation.’” Thank you for all that you do every legislation, practice management, education, thinking we are not primary care physicians day. n and research. Our new Member At-Large Dr. or social workers - we did not train in life- Harrison Alter joined our Board this year to saving Emergency Medicine to spend our In service and gratitude, help us answer some of the questions many own time doing this. I submit to you, we of us have been asking, like “How can we, as already are filling the roles of primary care and Chi Perlroth, MD emergency physicians, improve the health social work, meeting the needs where the President California ACEP
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2018 LEGISLATIVE SESSION UPDATE
By Tim Madden, Elena Lopez-Gusman, and Lauren Brown
n September 30, the 2017-18 Legislative Session officially came to a close. It seems that every year we say it was the busiest session in memory, and this year was no exception. We had an ambitious Oproactive agenda sponsoring a number of legislative proposals, including pursuing funding to place alcohol and drug counselors in emergency departments (EDs), securing GME funding for emergency medicine residency programs, and multiple bills to improve access to psychiatric care. In addition to our proactive agenda, we were also busy with hundreds of proposals which would have impacted your ability to provide care in the emergency department. While many of these bills were well-intended, some were poorly drafted and needed to be modified to avoid unintended consequences. Every effort to modify a bill takes a significant amount of work. Additionally, other bills were simply bad policy and we had to engage heavily in an attempt to defeat them. Below is a summary of those efforts. Because the two-year session has ended, any bill not signed into law by the Governor is dead.
6 | LIFELINE a forum for emergency physicians in california California ACEP Backed Budget Items Assembly Appropriations Committee Suspense File. AB 3115 (Gipson) Community Paramedicine - Position – Support $20 Million for Alcohol and Drug Counselors This bill was amended late in the 2018 legislative session to include most of the language that was We sponsored a budget request to provide $20 million for a grant program to place alcohol and drug in SB 944 (Hertzberg). This bill would authorize community paramedicine programs, including counselors in EDs throughout the state. We were encouraged to have both the Senate and Assembly alternate destination, hospice care, post-discharge care, and TB testing. This bill was vetoed by include the budget request in their versions of the budget. During the reconciliation portion of the the Governor. budget process, where the Legislature is negotiating the final deal with the Governor, our request did not make the cut. AB 1998 (Rodriguez) Opioids: prescription limitations - Position - Oppose This bill would require physicians to develop a very specific opioid safe prescribing policy. While However, sometimes ideas floated in the public policy arena take shape in different ways. We we have endorsed a safe prescribing policy which we encourage hospitals to adopts, the level of are pleased to report this is the case with our proposal. Department of Healthcare Services just specificity required by this bill would have hindered evolution in this quickly-changing health care announced it has awarded a grant of $9 million in funds received from the federal government for arena. The bill was amended a number of times but remained problematic. This bill was held on alcohol and drug counselors in targeted rural EDs of our selection. the Senate Appropriations Committee Suspense File. $40 Million of Proposition 56 Funds for GME SB 1152 (Hernandez) Hospital patient discharge process: homeless patients - We also worked on ensuring the $40 million in Proposition 56 funds for GME for emergency Position - Oppose physicians and primary care physicians would be properly allocated. You may recall, last year the When introduced, this bill would have made it nearly impossible to discharge a homeless patient Governor stole the money by reducing the UC budget and filling it with the Proposition 56 funds from your ED. We worked extensively with the author’s office and sponsors to amend the bill. intended for GME programs. This year we were successful in having the funds allocated correctly to We were able to obtain a number of amendments to soften the impact on EDs. Even with the GME programs even though the Governor once again tried to redirect the funds. This is a great victory amendments the bill still has an impact on your ability to discharge homeless patients on a timely for emergency medicine residency programs, enabling them to expand the number of residency basis. This bill was signed by the Governor. We are developing guidance for your EDs prior to slots in California. We are actively participating in a stakeholder group to determine allocation of implementation on January 1, 2019. these funds. AB 2789 (Wood) Health care practitioners: prescriptions: electronic transmission California ACEP Sponsored Bills - Position - Neutral This bill would require physicians to e-prescribe by 2022. We had taken an Oppose unless Amended AB 2099 (Gloria) Mental health: detention and evaluation position due to the challenges e-prescribing raises in the ED. We worked extensively with the author’s This bill would allow a copy of the 5150 paperwork to be used instead of requiring the original. This office on amendments to provide flexibility when prescribing in the ED. As a result we moved to a addresses a problem we have heard from multiple counties where a psychiatric facility receiving a neutral position. This bill was signed by the Governor. 5150 patient from an ED refused to accept the transfer because the original 5150 paperwork was not AB 2487 (McCarty) Physicians and surgeons: education: opiate-dependent patient with the patient. This bill has been signed by the Governor. (For more information see February treatment and management – Position - Support and September issues of Lifeline) When this bill was introduced it required physicians to take a CME course on the treatment and AB 2983 (Arambula) Health care facilities: voluntary psychiatric care management of opioid dependent patients. We took an Oppose position and worked closely with This bill would prohibit psychiatric facilities from requiring voluntary patients be placed on a 5150 the author’s office to instead state that physicians who take a course to obtain their “x-license” can prior to being transferred. This bill was signed by the Governor. (For more information see apply those CME credits toward their mandatory pain management CME. With that amendment we February and September issues of Lifeline) supported the bill. This bill was signed by the Governor. AB 451 (Arambula) Health Facilities: psychiatric care AB 3087 (Kalra) Provider rate setting – Position - Oppose This bill would have required psychiatric facilities to accept all patients with psychiatric emergencies This bill would have established a commission to set reimbursement rates paid by commercial regardless of their ability to pay. This bill was held in the Senate Appropriations Committee. insurers to healthcare providers, including physicians and hospitals. This bill was held on the Assembly Appropriations Committee Suspense File. California ACEP Priority Legislation AB 1790 (Salas) Physician and surgeons: continuing education: Valley Fever - Position - Neutral AB 1795 (Gipson) Community Paramedicine - Position – Oppose unless Amended This bill would have required physicians to take CME classes on Valley Fever. We took an Oppose AB 1795 would have authorized alternate destination pilot programs to be done statewide by position and spoke with the author’s office about why emergency physicians should be able to any county, without adequate patient safety protections. We asked for a number of amendments choose their CME courses. The author amended the bill to remove the mandatory CME requirement. including requiring licensing standards for sobering centers, EMTALA requirements that all patients We then moved to a neutral position. This bill was signed by the Governor. be treated equally, modeling of alternate destination programs after the pilot programs, and robust reporting requirements. The author and sponsors rejected these amendments. The bill was held on AB 2741 (Burke) Prescription drugs: opioid medications: minors - Position - Neutral the Assembly Appropriations Committee Suspense File. This bill would have limited the amount of opioids that could be prescribed to a minor to a five day supply. We worked closely with the author and her office and she agreed to take amendments to SB 944 (Hertzberg) Community Paramedicine - Position – Support exempt emergency physicians from the bill. As a result we removed our opposition. This bill was This bill would authorize a number of community paramedicine programs, including alternate defeated in the Senate Business and Professions Committee. destination programs, to be done statewide by any county. We worked closely with the author and the sponsor –to include the same as the amendments as we requested be included in AB 1795. Our AB 2760 (Wood D) Prescription drugs: naloxone hydrochloride - Position - Oppose amendments were accepted and which enabled us to Support this bill. The bill was held on the This bill requires prescribers to offer a naloxone prescription to patients:
FALL 2018 | 7 When prescription is 90 or more morphine milligram equivalents of an opioid medication per SB 1426 (Stone R) Pharmacists: authority to prescribe and dispense dangerous day; or drugs and devices SB 1426 would have allowed for an advanced practice pharmacist to furnish drugs and medical When an opioid is prescribed concurrently with a prescription for benzodiazepine; or devices from a formulary without physician supervision. This bill was defeated in the Senate When patient presents with an increased risk for overdose, including a patient with a history of Business, Professions and Economic Development Committee. overdose, a patient with a history of substance use disorder, or a patient at risk for returning to a high dose of opioid medication to which the patient is no longer tolerant. California ACEP Opposed unless Amended Bills We met with the author numerous times to raise our concerns, but our amendments weren’t adopted. This bill was signed by the Governor. AB 1250 (Jones-Sawyer) Counties: contracts for personal services AB 1250 placed barriers on contracting for physician services at county hospitals, by establishing AB 2193 (Maienschein) Maternal mental health – Position - Neutral specific standards for the use of personal services contracts by counties. The bill was amended to exempt This bill would have required physicians providing emergency medical services to screen patients physicians and we moved to a neutral position. This bill was held in the Senate Rules Committee. for maternal health conditions. We took an Oppose unless Amended position and worked with the author to clarify the bill would not apply to physicians providing emergency medical services. The California ACEP Support Bills author agreed to take amendment and we removed our opposition. This bill was signed by the Governor AB 1968 (Low) Mental health: firearms AB 3162 (Friedman) Alcoholism or drug abuse recovery or treatment facilities - AB 1968 would extend the length of the ban on firearm purchase for a person who has been assessed Position - Neutral and admitted as a danger to themselves or to others. The bill would also impose a lifetime ban on This bill would have allowed the state to deny an application for an alcohol and drug rehabilitation firearm purchase on patients who were admitted under the above circumstance more than once in a facility based on overconcentration. We took an Oppose unless Amended position and raised one-year period. This bill was signed into law by the Governor. concerns with the author on how this language may limit these needed facilities. The author agreed AB 2018 (Maienschein) Mental health workforce planning: loan forgiveness, loan to remove that language and we moved to Neutral. This bill was signed by the Governor. repayment, and scholarship programs SB 1426 (Stone) Pharmacists: authority to prescribe and dispense dangerous drugs AB 2018 would have amended the existing loan repayment program for psychiatrists to include and devices – Position - Oppose trainees and psychiatry fellows. This bill was held on the Senate Appropriations Committee This bill would have established a commission to recommend the development of a formulary Suspense File. for drugs an advanced practice pharmacists may furnish to patients. This bill died in the Senate AB 2058 (Chau) Vehicles: driving under the influence: cannabis Health Committee. AB 2058 would have separated the offense of driving under the influence of cannabis from other SB 1254 (Stone) Hospital pharmacies: medication profiles for high-risk patients - similar offenses for the purposes of data collection. This bill was vetoed by the Governor. Position - Neutral AB 2086 (Gallagher) Controlled substances: CURES database This bill would require a pharmacist to obtain medication profiles for high-risk patients in hospitals. AB 2086 would enable physicians to request a list of patients for whom they are a prescriber within We took an Oppose unless Amended position and the author accepted our amendments to clarify CURES. This bill was signed into law by the Governor. that the medication profiles could be obtained by any healthcare practitioner, not only a pharmacist. AB 2112 (Santiago) Federal 21st Century Cures Act: community-based crisis This bill was signed by the Governor. response plan: grant AB 2112 seeks to bring additional resources to California to improve crisis response by requiring the California ACEP Opposed Bills department to develop and submit an application for a federal grant to develop a community-based crisis response plan. This bill was signed into law by the Governor. AB 859 (Eggman) Elders and dependent adults: abuse or neglect This bill would have lowered the standard of proof for elder abuse from “clear and convincing” to a AB 2143 (Caballero) Mental health: Licensed Mental Health Service Provider “preponderance of evidence” threatening MICRA protections. This bill was vetoed by the Governor. Education Program AB 2143 would have permitted a physician assistant or psychiatric mental health nurse practitioner SB 562 (Lara) The Healthy California Act to qualify for loan reimbursement through the Licensed Mental Health Service Provider Education This bill aimed to create a single-payer insurance system in California, but provided no insight or detail Program if they agreed to practice in either of two settings: publicly funded facilities or in mental as to how that goal would be achieved. This bill was held in the Assembly Rules Committee. health professional shortage areas. This bill was vetoed by the Governor. SB 1240 (Stone) Prescription drugs: CURES database AB 2202 (Gray) University of California: school of medicine: San Joaquin Valley This bill would have required physicians to include an ICD-10 Code or a statement of the diagnosis Regional Medical Education Endowment Fund with each prescription. This bill was defeated in the Senate Business, Professions, and AB 2202 would establish an endowment fund for the creation of a branch of the University of Economic Development Committee. California, San Francisco School of Medicine in partnership with the University of California, Merced. SB 1264 (Stone) Medi-Cal: hypertension medication management services This bill was signed into law by the Governor. This bill, as introduced, would have allowed a pharmacist to receive Medi-Cal reimbursement for AB 2256 (Santiago) Law enforcement agencies: opioid antagonist hypertension medication management services, but did not define hypertension medication AB 2256 would authorize a pharmacy, wholesaler, or manufacturer to furnish naloxone hydrochloride management services. The bill was later amended to address our concerns and we moved to a or other opioid antagonists to a law enforcement agency. This bill was signed into law by the neutral position. This bill was held on the Assembly Appropriations Committee Suspense File. Governor.
8 | LIFELINE a forum for emergency physicians in california AB 2275 (Arambula) Medi-Cal managed care: quality assessment and performance immigration status. This bill was held on the Senate Appropriations Committee Suspense File. improvement SB 906 (Beall) Mental health services and substance use disorder treatment: peer AB 2275 would have required the Department of Health Care Services to establish a quality support specialist certification assessment and performance improvement program for Medi-Cal managed care plans. This program SB 906 would have required the Department of Health Care Services to establish a peer provider would include the establishment of quality improvement targets and a financial incentive program. This bill was vetoed by the Governor. certification program for support service providers in mental health and substance use settings. This bill was vetoed by the Governor. AB 2333 (Wood) Office of Emergency Services: behavioral health response AB 2333 would establish a behavioral health deputy director within the Office of Emergency Services to SB 910 (Hernandez) Short-term limited duration health insurance ensure that these individuals have access to the necessary services in the event of a natural disaster or SB 910 would prohibit the issuance, sale, or renewal of short-term limited duration health insurance a state of emergency. This bill was held on the Senate Appropriations Committee Suspense File. policies. This bill was signed into law by the Governor. AB 2384 (Arambula) Medication-assisted treatment SB 974 (Lara) Medi-Cal: immigration status: adults AB 2384 would have required health plans and insurers to cover at least one of five drugs used for SB 974 would extend full Medi-Cal benefits to all Californians under 19 and over 65 years of age, medication-assisted treatment of substance use disorders. This bill was vetoed by the Governor. regardless of their immigration status. This bill was held on the Assembly Appropriations Committee Suspense File. AB 2427 (Wood) Medi-Cal: anticompetitive conduct AB 2427 would have mandated strict punitive measures for Medi-Cal managed care plans that SB 1004 (Weiner) Mental Health Services Act: prevention and early intervention engage in anticompetitive conduct or do not comply with medical loss ratio requirements. This bill SB 1004 would increase state oversight of Mental Health Services Act spending by standardizing was vetoed by the Governor. prevention and early intervention (PEI) efforts and requiring counties to spend a portion of their PEI funding on early diagnosis of psychosis and mood disorder, college mental health outreach, and AB 2499 (Arambula) Health care coverage: medical loss ratios AB 2427 codifies medical loss ratio standards put in place by the Affordable Care Act, ensuring services, or childhood trauma prevention and intervention. This bill was signed into law by the they remain in place regardless of changes to Federal law. This bill was signed into law by the Governor. Governor. SB 1108 (Hernandez) Medi-Cal: conditions of eligibility or coverage AB 2597 (Arambula) Programs in Medical Education As introduced, SB 1108 would prevent the Department of Health Care Services from requiring work AB 2597 would have appropriated $9.35 million from the General Fund to the Regents of the or community engagement activities as a condition of Medi-Cal eligibility. This bill was signed into University of California for allocation to the University of California Program in Medical Education law by the Governor. (PRIME) and would require the expansion of student enrollment in PRIME. This bill was held on SB 1125 (Atkins) Federally qualified health center and rural health clinic services the Senate Appropriations Committee Suspense File. SB 1125 would allow for the reimbursement of mental health services and other services at a AB 2674 (Aguiar-Curry) Health care service plans: disciplinary actions federally qualified health center in a single day. This bill was vetoed by the Governor. AB 2597 would require the Department of Managed Health Care (DMHC) to investigate claims that SB 1363 (Moorlach) Personal income taxes: voluntary contributions: National a health plan is engaging in an unfair payment pattern. This bill was signed into law by the Alliance on Mental Illness California Voluntary Tax Contribution Fund Governor. SB 1363 would allow for individuals to make donations through the Voluntary Tax Contribution Fund AB 2804 (Waldron) Substance use disorder treatment workforce expansion to the National Alliance on Mental Illness California’s (NAMI-CA) Crisis Intervention Team program, AB 2597 would create one-year and five-year plans to expand the substance use disorder treatment which will assist peace officers in their training to deal with persons who are experiencing a mental workforce in California to aid in the treatment of alcohol and drug abuse. This bill was held on the health crisis. This bill was signed into law by the Governor. Assembly Appropriations Committee Suspense File. AB 2861 (Salas) Medi-Cal: telehealth: alcohol and drug use treatment California ACEP Support if Amended Bills AB 2861 allows for certified substance use disorder counselors and other practitioners to receive Medi-Cal reimbursement for substance use disorder services provided via telehealth. This bill was AB 1963 (Waldron) Medi-Cal: reimbursement: opioid addiction treatment signed into law by the Governor. AB 1963 would increase the Medi-Cal reimbursement rate for medication-assisted treatment, including naloxone, methadone, and naltrexone treatment. We requested that the author amend the AB 2895 (Arambula) Primary Care Spending Transparency Act bill to expressly include treatment provided in the emergency department. This bill was held on AB 2895 would have required health plans to report the percentage spent on primary care annually the Assembly Appropriations Committee Suspense File. and would have created a Primary Care Payment Reform Collaborative to review the data collected and propose best practices. This bill was held on the Assembly Appropriations Committee Suspense File. No Legislation Introduced
AB 2961 (O’Donnell) Emergency medical services Dynamex AB 2961 would help address the problem of ambulance patient offload delay by requiring local The Dynamex decision dramatically changed employment law and raises questions for emergency emergency medical services agencies to collect and submit relevant data. This bill was signed into physician groups and individual physicians who are organized as independent contractors. We are law by the Governor. actively engaged in stakeholder meetings and are working toward legislative action that would AB 2965 (Arambula) Medi-Cal: immigration status provide clarity for emergency physicians. While no legislative fix was introduced in 2018, we AB 2965 would extend full Medi-Cal benefits to all Californians under 26 years of age, regardless of their continue to push for a solution during the next session. n
FALL 2018 | 9 GUEST ARTICLE | CHAPTERRecipients AWARD
AWARD: CAL/EMRA AWARD DESCRIPTION: This award is given to an outstanding resident in recognition of their exceptional academic and/or advocacy efforts, or for exceptional efforts through, for, or on behalf of CAL/EMRA by a non-resident. RECIPIENT: Hannah Janeway, MD RECIPIENT BIO: Hannah Janeway, MD is currently a fourth year Emergency Medicine resident at Harbor-UCLA Medical Center. She received her MD from the Alpert Warren School of Medicine of Brown University and her BA from the University of Washington in International Studies and Comparative History of Ideas. She is currently the Committee of Interns and Residents (CIR) Regional Vice President for Southern California North and also the national Vice President for Women in Medicine. Her work focuses on educating students and residents on structural vulnerability, screening and intervening on social barriers to care in the Emergency Department, and emergency medicine capacity building in the developing world. STATEMENT: I want to thank California ACEP for this immense honor. I would also like to acknowledge the faculty at Harbor-UCLA who believed and supported me in all of my work and nominated me for this award. Most of all, I would like to express my highest gratitude to the patients at Harbor-
10 | LIFELINE a forum for emergency physicians in california 2018 CHAPTER AWARD Recipients
UCLA medical center who I have been honored to serve over the last 3 buprenorphine provider at Transitions Clinic in Oak Park, an underserved years. Residency can be difficult at times and working at a county hospital area of Sacramento, where he has volunteered with Harm Reduction is challenging. Yet, my daily frustrations have always been offset by the Service and conducted community-based research with people who patients I am privileged to serve at Harbor and who have inspired me use drugs for many years. He completed undergraduate studies at to not just continue to grow as a physician but also to engage with the Columbia Community College and University of Arizona, medical school community as a researcher and social activist. Indeed it is precisely this at UC Davis, masters in public health at Harvard, and surgical internship work that has provided me with the meaning and motivation that have at University of Washington. He is currently working on qualitative- sustained me in residency. As residents, we have a unique opportunity to quantitative research regarding injection-related skin and soft tissue bring in new ideas, to challenge the status quo and to push for improved infections and the role of pain, withdrawal, and perceived stigma in care environments for our patients and each other. I hope that together we care seeking behaviors of people who inject drugs, and implementing can continue to take risks and push Emergency Medicine beyond traditional protocols to enhance care for people with substance use disorders at UC platitudes in our respective hospitals, locally and nationally. Thank you. Davis, including ED-based buprenorphine. STATEMENT: Summers: I am humbled and honored by this acknowledgement. I would like to express my gratitude to my mentors in the harm reduction communities of Sacramento, Boston, and the SF bay area, as well as my colleagues, friends, and academic mentors at UC Davis and Harvard School of Public Health. I feel incredibly fortunate for the support of my department and the staff at Transitions Buprenorphine Clinic, including Dr. Neil Flynn. I would also like to thank the countless people living with and courageously confronting substance use disorders who have shared parts of their journeys and continually inspire me in this work. Finally, a big, and very special thank you to Dr. Aimee Moulin for her bold leadership and unwavering support in our endeavors to expand MAT treatment in our region and in our specialty. RECIPIENT BIO: Close and Grover: Reb Close, MD, FACEP and Casey Grover, MD, FACEP are Emergency Physicians at Community Hospital of the Monterey Peninsula, and two of the lead physicians for the Monterey County Prescribe Safe Initiative. Reb Close attended medical school at UCLA, and completed residency in Emergency Medicine at UCLA-Olive View Medical Center in Los Angeles. She has been practicing Emergency Medicine at CHOMP since 2003. She is currently a Board Member of California ACEP. Casey Grover is a native of the Monterey Peninsula, and also attended medical school at UCLA. He completed residency in Emergency Medicine at the Stanford University/ Kaiser Permanente program. He has been practicing Emergency Medicine at CHOMP since 2013. The Monterey County Prescribe Safe Initiative was established in 2014 in response to prescription drug addiction and deaths from drug overdoses in Monterey County. The initiative is a multi-organization collaborative with the goals of improving prescription drug safety, reducing inappropriate prescribing of pain medications and sedatives, increasing access to treatment for addiction, and increasing education of the public and medical providers on the dangers of prescription drugs. STATEMENT: Close and Grover: We are so grateful to receive this recognition for the work that is being done in California on the opiate crisis. For every success AWARD: CHAPTER SERVICE AWARD we've had, there are countless people that we've worked with to achieve it - from the California ACEP Board, to colleagues in other EDs in the state, DESCRIPTION: This award is given to a member who has served the Chapter by directing to organizations in Monterey county helping to provide better treatment for or coordinating a specific project or initiative, or who has served the addiction. We are so fortunate to be able to work with so many talented, Chapter Board and/or committees with distinction. dedicated, and inspiring people on this challenging topic of addiction and RECIPIENTS: Reb JH Close, MD, FACEP; Casey Grover, MD, FACEP; Andrew medication assisted treatment in the Emergency Department. We wish to Herring, MD; and Phillip Summers, MD, MPH express our gratitude to California ACEP for being so supportive of MAT in RECIPIENT BIO: Summers: Phillip Summers, MD, MPH has been working in the ED in general, and for providing us the opportunity to participate in harm reduction for nearly a decade. He is currently a second year the development of programs and protocols to help Emergency Department Emergency Medicine Resident at UC Davis. Prior to this he worked as a patients throughout California.
FALL 2018 | 11 2018 CHAPTER AWARD Recipients
RECIPIENT BIO: Herring: Andrew A. Herring, MD graduated from Harvard Medical USC in 1973-1974. He began practice in the emergency department of School and completed residency in emergency medicine at Highland Fountain Valley Regional Hospital in Orange County in 1974, which was Hospital—Alameda Health System in Oakland, CA where he continues just a few months after the newly constructed hospital was opened. He as an attending emergency physician and Associate Director of Research. grandfathered into ABEM in 1981. He took over the contract for staffing Dr. Herring is Medical Director of the Highland Hospital Substance the emergency department at Fountain Valley in 1976 and had the Use Disorder Treatment Program, and attending physician at the contract until December 1st of 2017. In December, he transitioned the Highland Hospital Interdisciplinary Pain Medicine Program. Dr. Herring contract to his physicians under the AAEM Practice Management group is the Principle Investigator of the California ED-BRIDGE | Emergency as an independent democratic group with all fourteen physicians being Buprenorphine Treatment Project. Dr. Herring is an Assistant Clinical equal shareholders. He is in the process of doing the same with his Professor at the University of California, San Francisco and conducted last remaining contract at Placentia Linda Hospital. Dr. Anderson was health policy research as a Fulbright Scholar in Central America. His president of the Orange County Medical Association in 1994. He was on current research focuses on emergency department treatment of opioid the Founding Board of Directors of CalOptima, which is Orange County’s use disorders and pain management. Dr. Herring is board-certified in Medi-Cal managed care system, from 1994-2002 and he was Chairman Emergency Medicine, Addiction Medicine, and Pain Medicine. for two terms. CalOptima has been a success story, and now has 850,000 STATEMENT: Herring: It is a tremendous honor to be acknowledged by the California covered lives in Orange County. He was awarded the Orange County Chapter of the American College of Emergency Physicians with the Chapter Medical Association “Physician of the Year” in 1999. He was on the Service Award. I have been humbled and moved by the dedication and Board of Directors of the Orange County Coalition of Community Clinics commitment of so many emergency providers in California to take the leap from 2001-2008 and was the Chair from 2006-2008. He continues to and begin innovative treatment pathways for patients presenting in crisis be involved with CalOptima, and is a representative of the OCMA and due to opioid use disorders. As emergency physicians we are at the true emergency physicians on committees dealing with indigent care, front-lines of the opioid epidemic and the position to make a profound behavioral health problems, and homelessness in Orange County. and lasting impact on the health of Californians. Through our efforts and STATEMENT: I have been blessed to be a part of the emergency medicine family for these those of our partners throughout the medical community, I hope to see 44 years that I have been in practice. I thank California ACEP for honoring the creation of a truly integrated and patient centered, system of care for me with the Chapter’s Distinguished Service Award. opioid use disorder that will make a concrete and demonstrable reduction in opioid related morbidity and mortality.
AWARD: EDUCATION AWARD DESCRIPTION: This award is given to a member who has made an outstanding contribution to the education of emergency medicine residents or who has made a significant contribution to emergency medicine research and education. RECIPIENTS: Jorge A. Fernandez, MD and Jan Marie Shoenberger, MD, FACEP RECIPIENT BIO: Fernandez: Jorge Fernandez, MD has served as the Chair of California AWARD: DISTINGUISHED SERVICE AWARD ACEP’s annual conference (now called AdvandED) for the last three years. DESCRIPTION: This award is given to a member who has made a significant contribution During that time period he has helped change the focus of the conference to emergency medicine throughout their career either through Chapter- to our future: EM residents and EM bound medical students; highlighted specific activities or through activities aligned with the Chapter mission, important issues facing all emergency physicians in California (including vision, and priorities and objectives. burnout, psych boarding, health policy/disparities); implemented high yield, rapid-fire lightning talks; and offered speaking opportunities for RECIPIENT: Peter G. Anderson, MD, FACEP, FAAEM not just academic physicians, but also community physicians, residents, RECIPIENT BIO: Peter Anderson, MD, FACEP, FAAEM attended Medical School at the and medical students in order to increase engagement at all levels of University of Wisconsin-Madison and completed an Internship at LAC- training and experience. Dr. Fernandez is faculty for UC San Diego and was recently elected to the California ACEP Board of Directors.
12 | LIFELINE a forum for emergency physicians in california STATEMENT: Fernandez: I am honored and humbled to have been awarded this thank you to my family and to my partner, Billy Mallon. You have always year’s education award by the California Chapter of the American College been there to cheer me on. Thanks again California ACEP! I am humbled of Emergency Physicians. It would not have been possible without the and grateful for this recognition! hard work and collaboration between so many talented, dedicated, and engaged physician educators, California ACEP staff, and California ACEP board members and leadership. It has been incredible to witness and guide the evolution of the Annual Assembly during the 3 years I served as Conference Chair. I would like to thank my colleague and good friend Dr. Leslie Oyama at UC San Diego, who dreamed up and planned this year’s innovative Escape Room competition, which combined the best of simulation games and quiz shows into one action-packed adventure, as well as Dr. Lori Winston at Kaweah Delta for her idea of a wellness art exhibit. Finally, I am so pleased that Dr. Jessica Mason from UCSF-Fresno will serve as the future AdvancED Conference Chair: She is an outstanding educator already with a career worth of educational experience. I am excited to see the growth of the conference in years ahead under her visionary leadership. I did not appreciate the importance of the work of Cal ACEP until witnessing it first hand through my interactions with California ACEP staff/board members during the last three years. In today’s volatile and unpredictable political environment, California ACEP allows us as emergency physicians to collectively advocate for our patients and our practices in a strategic, consistent, effective, respectful, and well-respected manner. I look forward to working with California ACEP leadership and staff in the years ahead. Finally, I would like to thank my family, friends, colleagues, and the AWARD: EMS ACHIEVEMENT AWARD leadership at UC San Diego for all of their support and encouragement. I am so grateful to live and work in California, and to be part of this DESCRIPTION: This award is given to a member who has contributed significantly to the community. improvement of the quality and/or coordination of emergency medicine within the larger emergency medical system. RECIPIENT BIO: Shoenberger: Jan Marie Shoenberger, MD, FACEP grew up in Palm Springs, California. She graduated from Palm Springs High School and RECIPIENT: Kevin Mackey, MD, FACEP went on to graduate from UC San Diego (B.S. in Biochemistry and Cell RECIPIENT BIO: With over 30 years of experience in prehospital care, Kevin Mackey, MD, Biology) in 1993. She graduated from USC School of Medicine in 1999, FACEP is a board certified EMS physician and currently serves as the completed an internship in Internal Medicine at Santa Barbara Cottage medical director for Sacramento Regional Fire Services, comprised of 4 Hospital 1999-2000, and completed her Emergency Medicine Residency fire departments and dispatch center that serve 1.6 million citizens with at Los Angeles County + USC Medical Center from 2000-2003, where over 180,000 calls for service annually. He is also the associate medical she served as Chief Resident from 2002-2003. She has been a Faculty director for a five-county regional EMS system in central California where Member at Keck School of Medicine of USC and Attending Staff at Los he is the Principle Investigator for a Community Paramedicine project Angeles County + USC Medical Center, Department of Emergency focusing on paramedic assessment and clearance of behavioral health Medicine, since 2003. She was the Associate Residency Program Director patients in the field. He is a full time emergency physician, is the president from 2003-2011 and the Residency Program Director from 2011-2018. of the Emergency Medical Directors Association of California, is the team Dr. Shoenberger is currently serving as Vice Chair of Operations and physician for Urban Search and Rescue California Task Force 7, and serves Clinical Education and is an Associate Professor of Clinical Emergency on the executive board of directors for the National Registry of EMTs. Medicine at the Keck School of Medicine. STATEMENT: I am honored and deeply humbled to have been selected by California STATEMENT: Shoenberger: I am incredibly honored to be the recipient of the 2018 ACEP to receive this award. Many of our patients experience their first California ACEP Education award. We have so many talented EM educators contact with professional care outside of the hospital from the men and in the state of California and I am proud to be a part of this community. I women who stand in the gap, ready to respond to the call 24/7/365. It have been lucky enough to be a member of the Department of Emergency has been a privilege to spend my entire professional career working with Medicine at the Keck School of Medicine of USC and the Los Angeles EMS physicians, EMS nurses, paramedics, EMTs, and dispatchers, who I County + USC Medical Center for 15 years. The patients at LAC+USC are call heroes. The future of EMS is bright, ever evolving, and California ACEP’s my everyday inspiration and it is a privilege to serve them. Over these partnership in shaping that future is vital and important for our patients. years, I have done my best to teach EM to all types of learners - nurses, paramedics, PA students, medical students, and residents. I thank all of them for their patience and feedback. I have also been active in CME AWARD: HOUSE OF MEDICINE AWARD settings thanks to people like Drs. Rick Bukata and Mel Herbert and I DESCRIPTION: This award is given to a member who has significantly improved the appreciate the opportunities they have given me over the years. Finally, standing and influence of emergency medicine within the house of
FALL 2018 | 13 2018 CHAPTER AWARD Recipients
medicine and done so through their leadership within and among other Services where he focuses on access to care and the social determinants organizations, especially other specialty societies, medical societies, and of health (SDOH), including SDOH screening and interventions across state and national health care organizations. clinical settings, medical-legal community partnerships (MLCPs), and RECIPIENT: Andrea Wagner, MD, FACEP re-entry from jail, including enrollment into Medicaid, discharge with a 30-day supply of medications, and accessing primary and specialty care. RECIPIENT BIO: Andrea Wagner, MD, FACEP is a practicing ED Physician at Kaiser San Francisco and Director of Outside Hospital and Emergency Services for He has a special interest in addressing SDOH such as food, housing, and The Permanente Medical Group. In that role she is the Medical Director financial strain to improve health. for EPRP in Northern California. He is a founding member of the UCLA Department of Emergency She is Board Certified in Internal Medicine, since 1981, and Board Medicine’s Section on International and Domestic Health Equity (IdHEAL, Certified in Emergency Medicine, since 1987. She has been a member of www.idheal.org), ACEP’s Social Emergency Medicine Section and is ACEP since 1987 and Fellow of the College since 1992. the section’s Chair-Elect, and SAEM’s Social Emergency Medicine and Population Health Interest Group. He earned his A.B. in Biochemical She joined The Permanente Medical Group in 1981 and has been practicing Emergency Physician for 37 years. She served as the Assistant Sciences from Harvard, JD from Yale, and MD from UC San Francisco. He Chief and Chief of Kaiser Martinez and then Walnut Creek from 1989- completed his residency in emergency medicine at the Alameda County 1997 and Assistant Chief of Kaiser San Francisco from 2002-2009. Medical Center/Alameda Health System Highland General Hospital training program where he co-founded the Health Advocates of Alameda She was appointed Member at Large to the California ACEP Board in Health System, a program that brings together volunteers and lawyers 2006, by Dr. Myles Riner, and served on the Board until 2012. She served with social workers to create a continuum of care for addressing SDOH. on the EMREF Board during her tenure on the Board. She remains active in California ACEP, ACEP Council, and the California Medical Association STATEMENT: I am honored to receive the California ACEP Humanitarian Award. I’d like House of Delegates. to thank my parents, friends, colleagues, and family for their support that STATEMENT: Thank you, California ACEP for this award. I am very honored to have has allowed me to pursue my interests and focus on caring for patients been chosen. I want to thank all the Board Members and Staff who have holistically, moving beyond the traditional medical model to incorporate taught me so much about advocacy and the legislative process over the addressing the social determinants of health into my daily practice. last 12 years. I hope all Medical Students, Residents, and young Emergency As emergency medicine continues to evolve and grow as a field, I hope that Physicians get involved with California ACEP and stay active in their we are able to maintain our humanity and remember that the emergency specialty organization. department remains the safety net for our most vulnerable patients, who often come to us because they have nowhere else to turn. Our patients may come to us complaining of chronic toe pain or years of chest pain, but these chief complaints are how patients have come to medicalize their cry for help within a broken safety net that does not recognize hunger and homelessness as valid concerns. I often think back to the first patient I ever saw in the ED, a gentleman who had multiple visits, labs, CT scans, and hospitalizations for his shortness of breath. He hated being in the hospital but could not get to the pharmacy to fill his medications. His insurance would pay for his ED visits, his bloodwork, his imaging, and even his hospitalizations, but refused to pay for the bus token to get him to the pharmacy. What a crazy system we have. As emergency medicine physicians witness the challenges and effects of social determinants in our daily practice, we must take the lead in addressing our patients’ needs. Instead of being frustrated, we must partner with our colleagues, our patients, and our community to ensure proper resource allocation, so that our patients have safe, habitable housing instead of being housed in the ICU; so that our patients have access to healthy foods instead of ending up on TPN; so that our patients have safe neighborhoods to exercise in instead of getting cardiac bypass surgery. AWARD: HUMANITARIAN AWARD Don’t get me wrong. This is a daunting task, one that requires both leadership DESCRIPTION: This award is given to a member who has dedicated or volunteered a and partnership, and one that we cannot go at alone. We must reach out significant amount of their time and expertise to the service of underserved beyond our comfort zone and engage with the many who are already doing patients or those affected by disasters or significant world events. this work. Only then can we truly do right by our patients, treating them RECIPIENT: Dennis Hsieh, MD, JD within the context of their lives and communities, instead of being frustrated RECIPIENT BIO: Dennis Hsieh, MD, JD is an assistant professor of emergency medicine at in isolation at 3 AM by their chronic toe pain or years of chest pain. Harbor-UCLA Medical Center and the David Geffen School of Medicine Thank you again and I look forward to partnering with you and California and is dually appointed at the Los Angeles County Department of Health ACEP to better care for our patients.
14 | LIFELINE a forum for emergency physicians in california AWARD: INJURY PREVENTION AWARD: MEDIA AWARD DESCRIPTION: This award is given to a member who has championed or led Chapter DESCRIPTION: This award is given to a member who has made significant contributions to activities, including legislation, local campaigns, or otherwise raised the improvement of the awareness, education, understanding and influence public awareness, on issues aimed at preventing injuries or illnesses of emergency medicine and the Chapter through all forms of media. among the public. RECIPIENT: Mark Langdorf, MD, MHPE, FACEP, FAAEM, RDMS RECIPIENT: Kevin Jones, DO, FACEP RECIPIENT BIO: Mark I. Langdorf, MD, MHPE, FACEP, FAAEM, RDMS is Professor of Clinical RECIPIENT BIO: Kevin Jones, DO, FACEP is an emergency physician with Vituity at Sutter Emergency Medicine at the University of California, Irvine. After medical Medical Center Sacramento and Sutter Davis Hospital. After completing school at UC San Diego, he did an EM residency, a fellowship in medical his residency in emergency medicine at Arrowhead Regional Medical education and the Master degree in Health Professions Education at the Center in Southern California, he then served as the Health Policy & University of Illinois, Chicago. He served as Program Director for the Advocacy Fellow with California ACEP and UCDMC. He served on the emergency medicine residency for 10 years, Medical Director of the Board of Directors for California ACEP for the past 4 years and has been Level I Trauma Center Emergency Department for 18 years, and Division active on the Chapter's Mental Health Work Group and Workplace Chief and then Department Chair for 20 years. He served as Associate Violence Task Force, helping develop and promote improved care and Dean for Faculty Development and CME, and Director of the Academy best practices for patients and providers in the emergency department. for Innovation in Medical Education at UC Irvine. He also served as Senior In an effort to increase awareness, he designed and implemented a Associate Dean for Medical Education. statewide poster campaign titled “Please care for us while we care He consults and speaks nationally and internationally to promote for you” that has been adopted by several hospitals and departments optimum trauma, stroke, and emergency care. He is Regional Faculty for throughout the state, with co-sponsorship by the CHP. He has also the Advanced Cardiac Life Support Course and also teaches Advanced lectured on workplace violence issues for several local and state ENA Trauma Life Support. He is the Editor-in-Chief of the Western Journal chapters and, in 2015, worked directly with Asm. Freddie Rodriguez on of Emergency Medicine (WestJEM), an open-access peer review AB 172 addressing penalties for assault and battery within the ED - a international journal, at www.westjem.com. He is the recipient of the bill that made it to the Governor’s desk, but was vetoed. He is also a Peter Rosen (renamed the Robert McNamara) Award for Academic member of the Sierra Sacramento Valley Medical Society Mental Health Leadership from the American Academy of Emergency Medicine. He also Task Force, where he is currently working to promote and implement the serves as Vice President of the Medical Staff at UC Irvine Medical Center. SMART medical clearance protocol. STATEMENT: I would like to thank my partners in the UCI Department of Emergency STATEMENT: It is a great honor to receive and be recognized for this award. Thank you Medicine for their continued encouragement and financial support in to my California ACEP colleagues, the California ACEP staff, lobbyist Tim developing WestJEM. I would especially like to recognize the Managing Madden, and fellow Board members for serving together to improve Associate Editor, Dr. Shahram Lotfipour, our university librarian, Linda care in the Emergency Department. It is an honor to work alongside one Murphy, and our interim Chair, Dr. J. Christian Fox. To the Advisory and another to make our departments safer for staff and our patients, and Editorial Board members around the world, as well as Section Editors and further the work of many colleagues that have come before me. reviewers, you have my eternal thanks. Finally, I recognize the founders of the journal, Dr. Amin Antoine Kazzi and Dr. Bob Derlet, without whose vision the journal never would have started.
FALL 2018 | 15 2018 CHAPTER AWARD Recipients
AWARD: SENATOR KEN MADDY POLITICAL AWARD: SPECIAL RECOGNITION AWARD LEADERSHIP AWARD DESCRIPTION: This award is given to a member who has made an important DESCRIPTION: This award is given to a person who, like Senator Maddy, has made a contribution to the Chapter or advanced specific Chapter objectives and/ lasting and indelible contribution to emergency medicine through or priorities by leading or directing an independent effort or initiative. significant legislative and/or political efforts. RECIPIENT: Maria Raven, MD, MPH, MSc, FACEP RECIPIENT: The Honorable Joaquin Arambula, MD and Aimee Moulin, MD, RECIPIENT BIO: Maria Raven, MD, MPH, MSc, FACEP is a practicing emergency medicine FACEP physician, health services researcher, and is an Associate Professor of RECIPIENT BIO: Arambula: Joaquin Arambula, MD was elected in April 2016 in a special Emergency Medicine at UCSF. Prior to joining the UCSF faculty in 2011, election to represent California’s 31st Assembly District. she completed her residency and a research fellowship at NYU/Bellevue Dr. Arambula was born and raised in the San Joaquin Valley and later Hospital Center and oversaw one of six New York State Department of attended medical school with the intention of returning to his home Health-funded Chronic Illness Demonstration Projects for the New York community to practice medicine. City Health and Hospitals Corporation and New York State Medicaid. She works clinically in the Emergency Department at Moffitt-Long and Prior to being elected to the State Assembly, he served in a senior conducts research related to emergency medicine payment policy and position with CEP America at Adventist Hospital in Selma and was frequent users of the health and social care system. She consults with appointed Medical Director in early 2013. Under his leadership, the the San Francisco Health Plan (SFHP) on program implementation and Selma Emergency Department won a number of awards. He also serves evaluation related to their highest cost health plan members and the as a mentor for the UCSF Fresno Doctor’s Academy, helping to encourage Health Homes Program. She is co-PI for the San Francisco Whole Person local students to enter the health care profession. Care Pilot evaluation, focused on improving care for chronically homeless In the Assembly, he has focused on efforts to increase access to healthcare high users of health and social care services. She is also the evaluator for low-income Californians and has authored multiple mental health for a Santa Clara County Pay for Success program, which provides bills for California ACEP. permanent supportive housing for chronically homeless frequents users RECIPIENT BIO: Moulin: Aimee Moulin, MD, FACEP completed medical school and of the County health system and jail. She is a course director for Program emergency medicine at USC. She served as Health Policy and Advocacy Evaluation in the UCSF Institute for Health Policy and Hastings Law Fellow for California ACEP in 2006 and served as the California ACEP School Health Policy and Law master’s degree course. Advocacy Fellowship Director from 2012-2017. During her time as STATEMENT: I am so honored by this award. It was a pleasure to have served with Advocacy Fellowship Director and Board Member she has engaged in such amazing emergency medicine colleagues to represent our specialty. stakeholder meetings on key policy areas, testified in committee, and Serving on the California ACEP Board of Directors has allowed me to see met one-on-one with Legislators to advance the Chapter’s policy goals. firsthand how we as practicing emergency medicine physicians – with She practices at UC Davis and has served as California ACEP President the guidance of our executive director and staff - can positively impact for the last year. emergency care in our state and nation. I am committed to continuing to conduct research and implement programs related to our patients’ social determinants of health, using the ED as a “hub” to coordinate care across the health and social delivery system. I am so grateful for the support of both our Board and specialty.
16 | LIFELINE a forum for emergency physicians in california I want to thank the Members and my fellow Board members for giving me the chance to provide leadership during these challenging times. It has been my honor to work on protecting and improving the emergency care system, to further the work of those that preceded me, and hand off well to those that will follow me. Lastly I would like to thank my family and partners for supporting my work with California ACEP. My Friend and Chairman Dr. Mark Brown acted as my sounding board and editor on my Lifeline newsletters. Thank you for my job, your intellectual contribution to EM, and your friendship. This award is a great honor. Thank you for recognizing my contribution to our great Chapter. n Congratulationsto all the AWARD: WALTER T. EDWARDS MERITORIOUS SERVICE AWARD Recipients DESCRIPTION: The Chapter’s highest honor, this award is given to a Chapter leader who, like Dr. Edwards, has distinguished themselves among their peers in the Chapter as demonstrating the highest commitment to emergency medicine and the Chapter, and who has made contributions to the Chapter that have significantly shaped its mission, vision, objectives, or priorities. C O N G R A T U L A T I O N S ! RECIPIENT: Lawrence Stock, MD, FACEP RECIPIENT BIO: Larry Stock, MD, FACEP is an emergency medicine physician who EMRA FALL 2018 AWARD completed the Harbor UCLA EM Residency program. He earned a BS in the RECIPIENTS FROM CALIFORNIA Biomedical Sciences Program at UC Riverside and an MD at UCLA. He is ACEP18 TRAVEL SCHOLARSHIP the Vice Chairman of the Emergency Department and Chair of the Ethics Dr. Allen Chang Committee at Antelope Valley Hospital (AVH) in Lancaster, California. AVH Stanford/Kaiser Residency is a public, district nonprofit center that serves as a Trauma Center, EMS Base Hospital, an Emergency Department Approved for Children, and cares ACEP18 TRAVEL SCHOLARSHIP for over 135,000 ED patients a year. AVH is a teaching site for the UCLA Dr. Tiffany Abramson Ronald Reagan/Olive View Emergency Medicine Residency Program. He is LAC+USC EMS Fellowship a Clinical Professor at the Geffen School of Medicine at UCLA. He served as the 2016-2017 President of California ACEP. He is a AUGUSTINE D'ORTA HUMANISM AWARD Dr. Hannah Janeway Diplomate and a Senior Examiner for the American Board of Emergency Harbor – UCLA Residency Medicine.
He has been involved in international emergency medicine for over 20 BE THE CHANGE GRANT years. He has worked in conflict and disaster zones in Africa, Europe, Asia, Dr. Cindy Chang and Latin America. He is the Trauma Director Emeritus for Community Harbor – UCLA Residency Partners International. Peak experiences include volunteering in Liberia (West Africa) in 2003 during their last civil war and in helping during the EDDA TRAVEL SCHOLARSHIP Ebola crisis in 2015. Dr. Kian Preston-Suni Harbor – UCLA Administration Fellowship STATEMENT: I want to use this opportunity to thank the outstanding California
ACEP Staff, led by Executive Director Elena Lopez-Gusman. Our staff is FACULTY TEACHING EXCELLENCE a professional, high performing team and the Board of Directors and Dr. Ryan Pedigo Members owe you a debt of gratitude for your vigilance and effectiveness Harbor - UCLA Clerkship Director/Assistant Professor in advocating for our patients and emergency care in California.
FALL 2018 | 17 ADVANCED 2018 SPONSORS ANTELOPE VALLEY EMERGENCY MEDICAL ASSOCIATES INDEPENDENT EMERGENCY PHYSICIANS CONSORTIUM VEP HEALTHCARE EMERGENCY MEDICINE RESIDENTS ASSOCIATION
ADVANCED 2018 EXHIBITORS ALLERGAN BMS/PFIZER
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Independent Emergency Physicians Consortium 696 San Ramon Valley Blvd., Ste. #144, Danville, CA 94526 925.855.8505 | www.iepc.org
CEMAF ANNOUNCEMENTS |
The California Emergency Medicine Advocacy Fund (CEMAF) has transformed California ACEP’s advocacy efforts from primarily legislative to robust efforts in the legislative, regulatory, legal, and through the Emergency Medical Political Action Committee, political arenas. Few, if any, organization of our size can boast of an advocacy program like California ACEP’s; a program that has helped block Medi-Cal provider rate cuts, lock in $500 million for the Maddy EMS Fund over the next 10 years, and fight for ED overcrowding solutions! The efforts could not be sustained without the generous SAVE THE DATE support from the groups listed below, some of whom have Legislative Leadership Conference (LLC) donated as much as $0.25 per chart to ensure that California April 23, 2019 | Sacramento, California ACEP can fight on your behalf. Thank you to our 2017-18 contributors (in alphabetical order): CALIFORNIA ACEP SPONSORED & CO-SPONSORED COURSES • Alvarado Emergency Medical Associates 41st Annual Emergency Medicine In Yosemite January 16-19, 2019 | Yosemite, CA • Antelope Valley Emergency Medical Associates • Beach Emergency Medical Associates SUBMIT A LIFELINE ARTICLE • Berkeley Emergency Medical Group Looking for a way to share your emergency medicine experience? Want • Centinela Freeman Emergency Medical Associates to share a story from your last shift? Or maybe career or life advice? We're • Chino Emergency Medical Associates looking for member and guest articles, including letters-to-the-editor. • Coastline Emergency Physicians Medical Group Please note that all articles and letters are reviewed and may be edited • Culver Emergency Medical Group for grammar and content. • Eden Emergency Medical Group If you would like more information or would like to submit a guest article, • Hollywood Presbyterian Emergency Medical Associates email [email protected]. • Las Cruces Emergency Medical Associates • Los Alamos Emergency Medical Associates • Mills Peninsula Emergency Medical Group • Montclair Emergency Medical Associates • Napa Valley Emergency Medical Group • Orange County Emergency Medical Associates • Pacific Coast Emergency Medical Associates • Pacifica Emergency Medical Associates • Riverside Emergency Physicians • San Dimas Emergency Medical Associates • Sherman Oaks Emergency Medical Associates • South Coast Emergency Medical Group, Inc. • Tarzana Emergency Medical Associates • TeamHealth • Temecula Valley Emergency Physicians, Inc. • US Acute Care Solutions • Valley Emergency Medical Associates • Valley Presbyterian Emergency Medical Associates • Vikant Gulati, MD • Vituity • West Hills Emergency Medical Associates
20 | LIFELINE a forum for emergency physicians in california | CALIFORNIA ACEP UPCOMING MEETINGS & DEADLINES
For more information on upcoming meetings, please e-mail us at [email protected]; unless otherwise noted, all meetings are held via conference call.
OCTOBER 2018 OCTOBER 2018 SUN MON TUES WED THURS FRI SAT
ACEP18 1st – 4th 1 2 3 4 5 6 San Diego, CA 7 8 9 10 11 12 13
14 15 16 17 18 19 20 CMA House of Delegates 13th – 14th Sacramento, CA 21 22 23 24 25 26 27
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Reimbursement Committee NOVEMBER 2018 6th at 9am Conference Call SUN MON TUES WED THURS FRI SAT
1 2 3 Board of Directors Meeting 7th at 10am Sacramento, CA 4 5 6 7 8 9 10
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Veteran's Day 12th 18 19 20 21 22 23 24 Office Closed 25 26 27 28 29 30
Thanksgiving 22nd – 23rd Office Closed DECEMBER 2018
SUN MON TUES WED THURS FRI SAT DECEMBER 2018 1
Winter Holidays 2 3 4 5 6 7 8 24th – 31st Office Closed 9 10 11 12 13 14 15
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FALL 2018 | 21 CAREER OPPORTUNITIES |
SOUTHERN CALIFORNIA – ORANGE COUNTY: Full time and part time SOUTH ORANGE COUNTY: Mission Hospital and Children’s Hospital at independent contracting emergency physicians needed for high volume, high Mission, a CMS 5-Star rated full service hospital. We are an established, acuity practices. Chest Pain Center, Stroke Center, Pediatric Level II trauma independent, democratic group staffing this ED for 22 years. Excellent center - large independent group with forty years of clinical excellence for two compensation; malpractice paid; scribes; midlevel providers. acute care facilities. Expanding group needs BC/BE emergency physicians and We seek an EM residency trained physician for a partnership track. Excellent pediatric emergency physicians. Excellent compensation, malpractice paid, coverage and midlevel provider support allow for high job satisfaction. UC scribes, midlevel providers, 8 – 9 hour shifts, excellent call panel coverage. Irvine EM residents on rotation allow for teaching opportunities. Two full-time, Email CV and references to [email protected], fax to 714.543.8914 dedicated nocturnists work 6 nights a week. All other physicians average 6 overnight shifts per year! SOUTHERN CALIFORNIA OPPORTUNITIES: The department serves both a pediatric and adult base station hospital • Tustin, CA - Orange County - 73-bed community hospital, 8-bed ER, serving all of south OC. High acuity, 70,000 patients a year, comprehensive paramedic receiving, low volume. 10 x 24hr = $240,000/yr + incentive referral center, outstanding adult and pediatric sub specialty coverage, adult and pediatric trauma center, STEMI Center, and Stroke Center. • East Los Angeles - 120-bed community hospital urgent care (non paramedic receiving) volume 700/mo. Guarantee $100/hr. Send CV to: [email protected] • Norwalk, CA - 60-bed hospital. 500-600 patient/mo. Paramedic receiving. $110/hr. VENTURA CALIFORNIA: New hospital under construction and scheduled to • San Fernando Valley - 18000 visits $350000 per year with incentives open in the Spring of 2018. Central coast of California and 70 miles from LAX. Med surg with psyche beds. Overlap or NP or PA for busy times. Positions available in two facilities for BC/BE emergency physician. STEMI • HOSPITALIST OPENINGS ALSO AVAILABLE Center, Stroke Center with on-call coverage of all specialties. Teaching facility with residents in Family Practice, Surgery, Orthopedics and Internal Medicine. FAX CV to 213 482 0577 or call 213 482 0588 or email [email protected] Admitting hospital teams for Medicine and Pediatrics. Twenty-four hour OB coverage in house and a well established NICU. Physician’s shifts are 9 hrs and To advertise with Lifeline and to take advantage of our circulation of over 12 hours of PA/NP coverage. All shifts and providers have scribe services 24/7. 3,000 readers, including Emergency Physicians, Groups, and Administrators Affiliated hospital is a smaller rural facility 20 minutes from Ventura in Ojai. throughout California who are eager to learn about what your business has Malpractice and tail coverage is provided. New hires will work days, nights, to offer them, please contact us at [email protected] or give us a call weekends and weekdays. at (916) 325-5455. Send resume to Alex Kowblansky MD FACEP at [email protected]
22 | LIFELINE a forum for emergency physicians in california Looking forwing California an providersITLS list: course? EMREF offers the follo PHI Air Medical, California Eric Lewis, Course Coordinator 801 D Airport Way, Modesto, CA 95354 Phone: (209) 550-0884 ETS – Emergency Training Services Fax: (209) 550-0885 Mike Thomas, Course Coordinator Email: [email protected] 3050 Paul Sweet Road, Santa Cruz, CA 95065 Web: http://www.phiairmedical.com Phone: (831) 476-8813 American Health Education, Inc Toll-Free: (800) 700-8444 Riggs Ambulance Service Perry Hookey, EMT-P Fax: (831) 477-4914 Greg Petersen, EMT-P, Clinical Care Coordinator 7300B Amador Plaza Road, Dublin, CA 94568 Email: [email protected] 100 Riggs Ave, Merced, CA 95340 Phone: (800) 483-3615 Web: www.emergencytraining.com Phone: (209) 725-7010 Email: [email protected] Fax: (209) 725-7044 Web: www.americanhealtheducation.com Loma Linda University Medical Center Email: [email protected] Lyne Jones, Administrative Assistant Web: www.riggsambulance.com American Medical Response (AMR) Department of Emergency Medicine Ken Bradford, Operations 11234 Anderson St., A108, Loma Linda, CA 92354 Rocklin Fire Department 841 Latour Court, Ste D, Napa, CA 94558-6259 Phone: (909) 558-4344 x 0 Chris Wade, Firefighter/Paramedic Phone: (707) 953-5795 Fax: (909) 558-0102 3401 Crest Drive, Rocklin, CA 95765 Email: [email protected] Email: [email protected] Phone: (916) 625-5311 Web: www.llu.edu Fax: (209) 725-7044 Compliance Training Email: [email protected] Jason Manning, EMS Course Coordinator Medic Ambulance Web: www.rocklin.ca.us 3188 Verde Robles Drive, Camino, CA 95709 James Pierson, EMT-P Phone: (916) 429-5895 506 Couch Street, Vallejo, CA 94590-2408 Rural Metro Ambulance Fax: (916) 256-4301 Phone: (707) 644-1761 Brian Green, EMT-P Email: [email protected] Fax: (707) 644-1784 1345 Vander Way, San Jose, CA 95112 Email: [email protected] Phone: (408) 645-7345 CSUS Prehospital Education Program Web: www.medicambulance.net Fax: (408) 275-6744 Thomas Oakes, Program Director Email: [email protected] 3000 State University Drive East, Napa Hall, Sacramento, CA Napa Valley College Web: www.rmetro.com 95819-6103 Gregory Rose, EMS Co-Director Office: (916) 278-4846 2277 Napa Highway, Napa CA 94558 Defib This (ERT) Mobile: (916) 316-7388 Phone: (707) 256-4596 Brian Green, EMT-P Email: [email protected] Email: [email protected] 1543 Pacific Avenue, Suite 104, Capitol CA 95060 Web: www.cce.csus.edu Web: www.winecountrycpr.com Phone: (831) 426-9111 Web: www.defibthis.com EMS Academy NCTI – National College of Technical Instruction Nancy Black, RN, Course Coordinator Lena Rohrabaugh, Course Manager Verihealth/Falck Northern California 1170 Foster City Blvd #107, Foster City, CA 94404 333 Sunrise Ave Suite 500, Roseville, CA 95661 Ken Bradford, Training Coordinator Phone: (866) 577-9197 Phone: (916) 960-6284 x 105 2190 South McDowell Blvd, Petaluma, CA 94954 Fax: (650) 701-1968 Fax: (916) 960-6296 Phone: (707) 766-2400 Email: [email protected] Email: [email protected] Email: [email protected] Web: www.caems-academy.com Web: www.ncti-online.com Web: www.verihealth.com
If you are an EMS Director and would like to provide chest, head shock-injury training to your team, contact California ACEP to get started! ITLS is the only pre-hospital trauma program endorsed by ACEP, since 1986, and is accepted internationally as the standard training course for pre-hospital trauma care.
Search for upcoming courses: http://cms.itrauma.org/CourseSearch.aspx
Please call 916.325.5455 or EMREF is a proud sponsor of California ITLS courses. E-mail Lucia Romo: [email protected] for more information. lifeline PRSRT STD California Chapter, American US POSTAGE College of Emergency Physicians PAID 1121 L Street, Suite 407 CPS Sacramento, CA 95814
Apply for Fellow Status! This year's deadline to submit your application to ACEP is December 15th. Don't miss out on FACEP designation!